Interest Survey

Please complete the form, where applicable, to join membership, sponsor the strategy conference, or join the newsletter list:

First name		Middle name
Last name		Title
Organization		E-mail
Street address		Address (cont.)
City		State
Zip/Postal code		Home Phone
Work Phone		FAX
URL

Please indicate your level of interest by selecting any of the following options that apply:

Conference Sponsor & Interim Membership
Donate a sponsorship as a show of support
I Pledge my First Year Membership contingent upon the published strategy*
Other

I will send a check, money order or some other payment by mail, to sponsor the strategy conference, in the following amount of $10.00 or more?

I prefer to pay using a credit card through paypal. Please contact me by email to arrange payment.

Yes No

I have the following suggestions or concerns for Strategy Conference issues.

I want to volunteer to help at the strategy conference, or assist with research or paralegal administration here in my state on a voluntary or paid basis. All volunteers complete the surveys.

Yes No

I want to fill out a survey regarding my interest in particular liberty issues.

Yes No

I want to fill out a survey regarding my beliefs and convictions.

Yes No

Interest Survey

Copyright information goes here. Last revised: December 13, 2003

Copyright information goes here.
Last revised: December 13, 2003